Lecture1 Protozoa Handout | Protozoa | Medical Specialties

Clinical Parasitology

Tropical Medicine International Health

Parasitology Clinical parasitology Tropical Disease Epidemiology International Health

Microbiology Clinical microbiology Infectious Disease Epidemiology Public Health



Institute of Parasitology, MacDonald Campus McGill Centre for Tropical Disease, MGH

Department of Microbiology, Lyman Duff International Health Office, Dept of Epidemiology




Animalia Protozoa


Subkingdom Phylum Phylum Phylum Phylum Subkingdom Phylum Phylum

Sarcomastigophora Apicomplexa Ciliophora Microspora Metazoa Nematoda Platyhelminthes


Toxoplasma malaria


Entamoeba histolytica Giardia Isospora Cryptosporidium Cyclospora Strongyloides Ascaris Trichuris hookworm pinworm tapeworms intestinal flukes


filaria Toxocara

Intestinal protozoa

Cestodes Trematodes

hydatid cysts cysticercosis Schistosoma liver flukes lung flukes


Animalia Protozoa Sarcodina Mastigophora

Taxonomy Protozoa
Entamoeba Giardia malaria Balantidium microsporidium


Phylum Sarcomastigophora Subphylum Subphylum Phylum Phylum Phylum

..“eukaryote”..has genetic material encased in a nuclear membrane (unlike bacteria and viruses) ..classified traditionally by morphology (eg. organelles of locomotion), life cycle and mechanisms of reproduction etc.

Apicomplexa Ciliophora Microspora

Mastigophora: movement with flagella - e.g. Trichomonas,


Sarcodina: pseudopodia, e.g. Entamoeba histolytica Apicomplexa: apical complex, no locomotor apparatus;
sexual reproduction, e.g. cryptosporidium, malaria, toxoplasma

Pathogenic Entamoeba histolytica Balantidium coli Giardia lamblia Dientamoeba fragilis Cryptosporidium parvum Enterocytozoon bieneusi Septata intestinalis Cyclospora cayetanensis Isospora belli

Commensal Entamoeba hartmani Entamoeba dispar Entamoeba coli Endolimax nana Iodamoeba bütschlii Chilomastix mesnili Trichomonas hominis Blastocystis hominis

Ciliophora: movement with cilia, e.g. Balantidium.

Trophozoite: any stage in a protozoan’s life cycle which can ingest food. In practice also refers to the motile form. Cyst: the non motile form which is protected by a distinct membrane or cyst well. This is an infective stage of the parasite.

Intestinal protozoa

Excystation: the process of emergence of the trophozoite from the cyst (vs. encystation) Pseudopod: literally means false foot; temporary cytoplasmic processes at the surface of the trophozoite

Entamoeba histolytica

Subphylum sarcodina

Entamoeba histolytica trophozoite with ingested RBCs

Epidemiology of Entamoeba histolytica Man the only source (not a zoonosis) Fecal-oral transmission Our understanding is in transition because of mis-identified cases. Seen in travellers, Saskatchewan native population

1) assymptomatic carrier state 2) acute amoebic dysentry 3) amoebic liver abscess 4) amoeboma

AMOEBIC LIVER ABSCESS Presentation 1. persisting fever 2. RUQ or epigastric pain and/or shoulder pain 3. rarely diarrhea Diagnosis 1. ultrasound 2. raised WBC 3. serology 4. aspirate microscopy 5. response to metronidazole 750 t.i.d.

Laboratory problems 1. sensitivity 2. specificity

Sequential Stool Examination for E. histolytica 1 direct direct and concentration direct, concentration and stain 2 3 4 5

13 25 34 43 50 % 21 38 51 61 69 %

41 65 79 88 93 %

Entamoeba . histolytica

Cogwheel distribution of chromatin and central karyosome

Entamoeba histolytica/dispar

E. histolytica

E. dispar

(antigen capture, PCR, culture and zymodemes)

Drugs for Entamoeba histolytica
Tissue: ..metronidazole, tinidazole, secnidazole, ornidazole ..emetine ..dehydroemetine ..chloroquine Bowel lumen: ..paromomycin (Humatin) ..diiodochlorhydroxyquin (Diodoquin) ..diloxanide furoate (Furamide)

Giardia lamblia
Subphylum mastigophora

Normal small intestine mucosa

Villus atrophy Crypt hyperplasia

GIARDIASIS Giardia epidemiology: - faecal oral spread - prevalence 3-5% in Canada; increased in travellers, backpackers, institutions, day care centres - zoonosis - found in most mammals; esp. beaver (“beaver fever”), cattle, cats, dogs, etc.
Symptoms diarrhea flatulence abdominal cramps decreased appetite + weight loss + nausea no fever Signs Laboratory mild abdominal no leukocytes in tenderness stool no mucous in stool giardia cysts intermittent in stool giardia cysts in duodenal aspirate

Cryptosporidium parvum Phylum apicomplexa

3-5 microns

CRYPTOSPORIDIUM Epidemiology: - bovine reservoir - epidemic contamination of municipal water Biology: - lives in small intestine epithelial cell membrane - Apicomplexa life cycle - diarrhea 2-3 weeks (chronic in AIDS) - cholecystitis


Cyclospora cayetanensis

Cyclospora cayetanensis
Taxonomy: Apicomplexa Epidemiology: in travellers to tropics (Nepal, Americas)
: raspberries from Guatemala

Biology: lives in small intestine epithelial cells Clinical: prolonged diarrhea (2-6 wks)
7-10 microns

Treatment: Septra

Treatment of intestinal protozoa
Entamoeba histolytica
metronidazole diloxanide furoate diodohydroxyquinoline metronidazole atabrine nil

1. Hematoxylin - E. histolytica, Giardia, D. fragilis, Isospora

Giardia Cryptosporidium Cyclospora

2. Modified Ziehl-Neelsen - Cryptosporidium Cyclospora 3. Trichrome - Microsporidium


Trichomonas vaginalis
Taxonomy: Mastigophora Epidemiology: reservoir is human urogenital tract Biology: causes inflamation of vaginal and urethral epithelium Clinical: vaginal discharge Treatment: metronidazole

Your present understanding
commensalism zoonosis

Your future challenges
1. Host immunological reaction to protozoa 2. The protozoan’s host immune avoidance 3. Laboratory diagnostic tools PCR, antigen capture, proteomics 4. Orphan drugs 5. Lack of Cryptosporidium treatment

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